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Oxibrcr NO. 152113 ORA
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map ° Parcel �y Permit# -7 6 G
Health Division
1rj2`' ' I �' Date Issued
Conservation Division �'� Ja c0 0� v �� Fee ��
Tax Collector
Treasurer ? 1
Planning Dept. O tiC Checked in By
Date Definitive Plan Approved by Planning Board \ Approved By
Historic-OKH Preservation/Hyannis
Project Street Address Ale
Village
Owner Address .692E
Telephone -
Permit Request AUD - e .
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Valuation o c� Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family EJ Two Family 0 Multi-Family(#units)
Age of Existing Structure coo W� Historic House: ❑Yes ErNo On Old King's Highway: ❑Yes TrNo
Basement Type: D Full O Crawl Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing_ new
Total Room Count(not including baths): existing new First Floor Room Count y
Heat Type and Fuel: dGas ❑Oil O Electric ❑Other
Central Air: ®'S'es ❑No Fireplaces: Existing !Vn New Existing wood/coal stove: ❑Yes; 2No
Detached garage:0 existing 0 new size Pool:0 existing ❑new size Barn:O existing ❑new,,','
ze
. t
Attached garage:O existing O new size Shed:O existing ❑new size Other: `'; ry
Zoning Board of Appeals Authorization O Appeal# Recorded❑
_Commercial ❑Yes O No If yes, site plan review#
Current Use Proposed Use
��)) BUILDER INFORMATION
Name C/c� Telephone Number ��19mr j93 Abof12
Address License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
e
SIGNATURE DATE
_ FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
3
MAP/,PARCEL NO.
ADDRESS VILLAGE
OWNER
< DATE OF INSPECTION:
FOUNDATION pw�
pp V
FRAME
INSULATION e,,,��t
FIREPL� i���n ./
ELE ROUGH FINAL
PLUMBING: ROUGH FINAL `
C;
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
f .
ASSOCIATION--PLAN NO.
I
I I.
f
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings $100.00
Residential Addition $50.00 �n,
Alterations/Renovations $50.00
Change of Contractor/Builder $25.0.0
FEE VALUE WORKSE EET
-NEW LIVING SPACE
square feet x$96/sq,foot= x.0041=
plus from below(if applicable)
ALTERATIONSMENOVATIONS OF EXISTING
square feet x$64/sq.foot= x.0041= �o
plus from below(if applicable).
GARAGES'(attacbed&detached)
square feet x$32/sq,&= x.0041=
ACCESSORY STRUCTURE>120 sq.ft.
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf- 1000 if 75.00
>1000 sf- 1500 sf 100.00
>1500 sf-Same as new building permit:
square feet x$96/sq,foot= x.0041=
STAND ALONE PERMITS U
Open Porch x$30.00=
(number)
Deck x$30.00=
(number)
Fireplace/Chimney x$25.00=
(number)
Inground Swimming Pool $60.00
Above Ground Swimming Pool $25.00
Relocation/Moving $150,00
(plus above if applicable)
s
Permit Fee
Town of Barnstable
o�t�
Regulatory Services
Thomas F.Geiler,Director
D 39. �.� Building Division
prEO MPy Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
ice: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE.
JOB LOCATION,,— ��25 /"// OA� A/G mot/• /�I�'/1��A
number street village
s01,E0WNER /%/�/.�i ez IQZ( � ��,�1i
name % home phone# work pbone#
CURRENT MAU-ING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
su ep rvisor. .
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
resuonsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of H
Approval of Building Official
Note: Three-Family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code States that: "Any homeowner performing work for which a building pernrit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities.of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a fom•Jcertification for use in your community.
L rl•fn.+nc•lmm�nvvmnt
o� E Town of Barnstable
° Regulatory Services
BA
`' Thomas F.Geiler,Director
�Efl; ,;►`. Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization;conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: �Ub Estimated Cost
Address of Work:
Owner's Name: /%/(�xj% �.o Avcz Z�.Ctl
Date of Application:
--
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
❑Job Under$1,000
[]Building not owner-occupied
[]owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WTTH.UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
-- 41 -
� OR
Date Owner's Name
Q:forms homeaffidav
The Commonwealth of Massachusetts
Department of bidastkal Accidents
Office of Investigations• • .
600 Washington Street
Boston,MA 02111'
www mas&gov/dia
Workers' Comp.,
Insurance Affidavit: Builders/Contractors/Electriciaris/Plumbers
• Applicant Infflrznation � • Please Print Legibly
Nye (B4ness10rganizatiow1h&vidu4:
Address:
/✓��, Q ci
- City/State/Zi GeJ r e Phone#: S'oS •9�/8'
1?:
Are you an employer? Checkthe•appropriate bog:. .Type of project(required):
4. ❑ I am a general contractor and I 6 Now construction
1.❑ Z am a employer with_* , have hired the sub-contractors ❑
employees (fuIl'and/or part time). listed'ou the attached sheet, $ Remodeling
2.M I am a sole proprietor or p miner-
and have no employees These sub-contractors have •8. •❑ Demolition
ship workers' comp.insurance. 9. ❑ Building addition
working for mein any capacity.
(No work6W comp.insurance 5• ❑ We area corporation and its 10.[] Electrical repairs or.additions
required-] officers have exercised their
t of exemption per MGL 1"1•❑ plumbing repairs or additions
3.[�I am a homeowner doing all work . � p
c. 152,§1(4), and we have no.. 12.❑ Roof repairs
myself..[No workers comp. employees. [No workers'
insurance required.]' 13'' Other
camp.insurance required.]
*Any applicant that,checks box#1 must also M out the section-below showing their workers'compensation policy information
t Homw eoners•who submitibis affidavit indicating they are doing all•work and then bire outside contractors must submit anew affidavitiadicatiag such
;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers' Vohcy srtoraratroa-
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance.Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:'
Job Site Address: y/State/Zap.
Attach a copy of the workers' compensation policy declaration page(showing the policy number and•expiration date).
Fafiure to,secure coverage as required under Section 25A of MGL c. 152 cari lead to the imposition of criminal penalties of a
fine up to$IAOO W and/or one-year imprisomnent, as well as,civil penalties in the form of a 5TOP'WORK ORDER and aline.
of .p to$250.00 a day against the violator. Be advised that a copy of this statement,may 6e forwarded to.the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and pelraliies of perjury that the information provided alcove is true and correct.
signacme: ate:
-�6
Phone#:
EOther
only. Do not write in this area,to be completed by city or town official.
n: Permit/License# ,
hority(circle one):
Health 2.Building Department 3.City/Towa Clerk 4.Electrical Inspector 5.Plumbing Inspector
rson: Phone#:
Information and Instructions. :
to provide workers' compensation for their employees.
Massachusetts General Laws chapter 1521egiiires all employerscontract of hire,
Pursuant to this statute, an employee is defined as"...every person am the service of another under any
express or implied,oral or written." tvvo or more
ed aS"34 W4)1A-,P2pers14,-.association, W. pora,10 or other legal entity,or any ,
An employer is defin and m�hi�ing the legal representativos of a deceased employer,or the'
of the for engaged in a joint enterprise, Howe�er:tlte
receiver or trustee of an individual,partnership, association or other legal entity, employing employees.•d who resides therein,or the ant of the
owner of a dwelling housa having not S persons
too e�ce,connstructionn o repair wo Yti such dwellng house
dwelling house of another who emp yS P
or on the grounds or building appurtenant mom°shall notbecause of such employmentbe deemed to be an employer."
GL chapter.152, §25 C(�also states that"every.state or local licensing agency shall withhold the Issuance or.
M permit to o erate' a business or to construct buildings in the commonwealth for any
Tenewal of a license or p P.
applicant who'has not produced acceptable evidence--of compliance with the insurance coverage required.".
dditionally,MGL chapter 152,§25C(7)states"Neither flee commoIIwealth nor any of its-political subdivisions shall
A
enter into any contract for the Performance of public work until acceptable evidence of compliance with the insurance
iequirements of this chapter have been presented to the contracting authority."
Applicants
ens ation affidavit completely,by checking the boxes that apply to your situation and,i
Please fill out the workers' compf.supply.sub-contractOT(s)name(s),addresses)and phone numbers) along with.their certifieate(s)of
necessary, Companies(LLC)or Limited Liabiity Partnerships(LLP)with no employees other than-the
insurance. Limited Liability Comp ation. _ an LLC or LLP does have
members or partners; are not required tD tlus a affidavit may be submitted to the Depaartment of Industrial
employees,a.policy is required Be advised
Accidents for confirmation of insurance coverag . or the pelt or license its being req I ate the uested, not the Department of Should
be returned to the crtY or t�that the applicationf P
Industrial Accidents. Should you have any questions regarding the law or if you are required to obfiain avur)c rs'
lease call the Department at the number listed below.. Se ur
lf-insed companies should enterthefr
compensation policy,p te line.
self-insurance license number on the appropria
City or Town Officials .
Please be sere that the affidavit is complete and printed leglMy, The Departln� thas contactvided a space ou regarding the hapPhcanm
of the affidavit for you to fill out in the event the Office of Investigations has n Y licant
Please be sure m fill in the permittlicense number which will be used as a reference number. In,addition, an ape
that mast submit multiple permit/license applications in any given Year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address h applicant
should the y ri locationstown� in
to�e or
ll
tom).
"A copy of the•affidavit that has been officially stamp Y
applicant as proof that•a valid affidavit is•on•file for; e=nse o�er�mit not elated to any bufisamess�be filled out-each
mmercual venture
year,Where a home owner or citizen is obiaiaing a P
(i e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit
,lhe �o f Investigations would like to thank you in advance for your cooperation and should you have any questions,
Offiplease do not hesitate td give us a call.
The Department's address,telephone and.fax number:
The Commonwealth of Massachusetts .
t of udu•strial Accidents
.I�epaztmen .. . . .. ,
. . .. Office of Investigations
. a 600'Washingfon Street .
Boston,MA 02111.-
Tel. #617-727-4900 ext 40.6 or'1-877-MASSAYE
Fax#617-727r7749
Revised 5-26-05 www,mass.gov/din
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TableJ=1b(continued)
A Prescriptive Packages for One and Two-Famlly Residential Hnildiaga Head w4h Fou Fuels
• MAXIMUM MINIMUM
Glazing Glaring Ceiling Wall Floor .Basemen! Slab HeninglCooling
eter Equipment EMci=gl
Area, U-valubi R-values R-value' R values Wall R+mee
P=kaee R-vatuef
3701 to 6500 Heating Degree Daye - N°tmal
Q''-12"!e 0:40—�38, '13�
R 12•/. 0.52 30 - - 19 19 10 6 Normal
S t2•/. 0-M 33 13 19 l0 6 u E
38 13 25 MA - —Ptorrnai- ---
:: 0.46 33 19 19 10 �- -
- 'VIA 8S:AFUF :. ::. ... .
38 13 25 NIA 85 AFUE
W .15Y• 0.52. 34 19 19 10 6
X 18% 032 ' 38 13 25 NIA NIA NOMW.
Y im ' 0.42• 38 19 25 NIA NIA N°
Z - t8•/. 0.42 38 13 19 10 6 90 AFVE
AA 18•/. . 0.50 30 19 19 1Q 6 90 Al'UE
1.-ADDRESS OF PROPERTY;
2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS:.
3. SQUARETOOTAGE OF ALL-GtrAZING: - ••
4. %GLAZING AREA(#3 DIVIDED BY#2):
5. SELECT PACKAGE(Q--AA-see above):
NOTE: OTHER FORE INVOLVED MBTHODS OF DETERMINING ENERGY REQUIREMENTS
ARE AVAILABLE. ASK US FOR THIS INFORMATION'
BUILDING INSPECTOR APPROVAL:
YES: NO:
q•fotms-580303E
780 CMR Appendix J '
Footnotes to Table J5.2.1b: lass doors, skylights, and
i Glazing area is the ratio of the area of the glazing assemblies ('including sliding-g
aque
basement windows if located is walls that enclosea oilglazingdarspace,
a may be excluded but excluding from the U-valudoors)-to eoss
area,expressed as a percentage.Up to 1/o of the
For example,'3 if of decorative glass may be excluded from a building design with 300 if of glazing area.
1 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with
the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3.a. U-values are for
whole units: center-of-glass U=values cannot be used.
3 he.ceiling.R-values do not assume a raised or oversized trusscon-30 struction.elation may ble subafion stituted for R738
_ insulation thickness over the'exterior, walls-without compression,
insulation'��1Z-3'8 insu�afion may be"stab titufed'for R-49'insulation: Ceiling R-valries m.present um
-the-s ••of cavity—
insulation plus insulating sheathing (if.used):For ventilated ceilings, insulating shea%ing must.be.placed between .
the conditioned space and the ventilated portion of the roof. if use Do not include`
wall R-values represent the sum-of the wall cavity insulation plus insulating 5heatbiag(' �•
exterior siding, structural sheathing,.and Interior drywall.For example,an R-19.requirew Wall c uld be mPt ments apply o
by R-19 cavity insulation OR R 13 cavity insulation plus R 6 insulating apply
q
wood-f9 ca- it mass(concrete,masonry,log)wall constructions,but do not 1 to metal-frame construction-
°The floor requirements apply to floors over unconditidned spaces(such as unconditioned crawlspaces;basements,
or garages).Floors over outside air must meet the ceiling requirements.
The entire opaque portion of any individual basement wall with an average depth less than 5doerse of con
-grade walls, windows and sliding g.. ditioned.
meet the same 'R=value requirement as above
baserrients must be included with the other glazing. Basement doors must meet,the door.U-value requirement
described in Note b.
The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs.
an to'histall more
If the building utilizes eleotric resistance heating use piece cooance ling equipment, the equiiprri nt with lowest
than one piece of heating equipment or more than on
.efficiency must meet-or exceed the efficiency required by the selected packago. ;
For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a
NOTES:
a)Glazing areas and.U-values are maxim=acceptable
ce tab to l i ude Insulation
components.a minimum acceptable-levels.
R value requirements are for insulation only
and• b)Opaque doors in the building eaveIope mu ee ���u than��o Door U-values must
door
and documented by the manufacturer in accordance withgreater taken from the U tested
'
aggregate U-valut rating
that
r is not available, include the
in Table 11.53b. If a door contains glass and a use the opaque door U valuer o determine compliance of the door.
glass area of the door with your windows an
One door may be excluded from this requirement(I areas may Have a U-value greater then 035).
th
c)If a ceiling,wall,door,basement wall,slab-edge,or craw.1 space wall component if the area-weighted average RvaluedIs greater than or egiiali o
different•insulation levels,thes two or more
e component complies
the R-value requirement for that component. Glazing or door components comply if the area-weighted average U-
yalue of all windows or doors is less than or equal to the U-value requirement(0.35 for doors).
43
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,
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��rI3RCKS �_ �y A
Aj, +s.
411
F�a� CART-IFIE,p PLOT :. "PLid;Nr�
Rouffu 5 "w. }• r r y �b/� 'is
4 BRUCE � � LOT, '
Ut2E A y -r—•
r y IN . ,.+
StALE's / ., v' DATE FeL�G'K aS��
GE' ENf� EE INr^i C ,l 176 ERTIFY THAT- THE Fo,4N1Q,9 <.
CLIENT..
.,s E819TERED RJEOISTER O SH,�.W.N ON .THIS. PLAN I3 LO�ATIE
:k 008 NO.83 ON TH.E �ROUNQ A9 IN�ICATEQ.�,I� O rf �.
CIVIL LAND ►;
' r'r ENQINEER SURVEY pR,BYt _17Dt� . CONFQRM§ .;TO THE ZQ.NINO Yt.l11�f�y Y
., --
;., OF -9ARN$TABLE MA
712 MAIN STREET ' •.. CH:QY,
^� t?` x r
HYANRIS MASS. r, L t
�
Assessor's map. and lot number �il ......... �T.... r
ypi f N E r0�
Sewage Permit number S w�Q R ♦�
I BARNSTABLE, i
House nuf7/16er.................................................................... gO Mb 9.
YAa
O
0 Y `
TOWN OF . BARNSTABEE
BUILDING INSPECTOR r
APPLICATION FOR PERMIT TO ..............
TYPE OF CONSTRUCTION .............................�i1 �)..� . .......... :`���` ...........................................
TO THE INSPECTOR OF BUILDINGS: f
The undersigned hereby applies for a permit according to the
following i formation: /
Location .... ... .....C.,,,
. .... ....... .... ... . .. ..... ...... . .. .. ....
.'t y�
Proposed Use ............................ ......................
.........7.......... ......!.. .. ......................................................................
Zoning District ) F Fire District .................. .... ..v..................... ....::..
Name of Owner ............1...�� /1lur.�,�,(��I'Address ..................��.f�`�.....��.� ��f �!!!/./-e
Name of Builder .................... 9..L.. :................................Address
Name of Architect ..................................................................Address .....................................
Number of Rooms Foundation f.7L�................ . ................................. .................. f�...a.......................
Exterior .............. G�...... �!..'.�.%/.r`5.........................Roofing / ... ��. .......
�
Floors �......................................................Interior ................................... ...........................................
�i1-- Heating :. r:. ::................::.....:.-:...........:.....7.::..:.......::::..:.:.Plumbing,.::....................... .... .. --.....................................
Fireplace ................... y..............................Approximate. Cost ................. \ i u O U
/ �. .�.................................
Definitive Plan Approved by Planning Board _______fP-� V________19 Area_ ............................................
Diagram of Lot and Building with Dimensions r /rZ J��U U�(S
I Fee ....................... .
SUBJECT TO APPROVAL OF BOARD OF HEALTH Z / V d( I
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstabte,`rregarding--the above
construction.
Name .................:.. ................ ..........
... .). ... ...........
Construction Supervisor's License ... .................../ �/ j. .
�
GREENBRIER C0RP. A=174-2
No ._. Permit for 1�
..�:....S.....toK .................2749�h.,
1
S ?gleaFamily Dwelling.....................
r
Location .....tot..22.� 58 Minton.Lar1�.,,,,,,,
...le 4r45We `
Owner ... .Greenbrier..Corp.
...............................
...........
i .......... ........... .......... .
' Type of Construction Frame.............................
. i
...........::...................................
Plot ............................ Lot.................................
i
Permit Granted ... ............19 85
Date of Inspection ....................................19
Date Completed ......................................19
Assessor's map and lot numbei . .....,
THE
S O K �,� o`'�f roe♦
Sewage Permit number .......... .......:... ...................... SEPTIC Si Cj
s..$. INSTALLED IN ����`�. t B��a LB.
House number r
c WITH TITLE °o 2639.WAY
�0
TOWN OF BARDS,%, �,,T'ff E
BUILDING INSPECTOR . r
APPLICATION FOR PERMIT TO ............. .... .... ....... . ......... .... .........! ........ .................... ..................
TYPEOF:CONSTRUCTION ............................d/IQ..( .J�.......... ...........................................
.............
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a ermit according to;;�;�
ation: ,�QQ
Location C......1 ............................................
... �2.:. ........ :.1... ......01VAIW/A(
. .... ....... .... .. ... . ..... ....
Proposed Use ............................/...�.�f ...........1..... /Lla' ............................................
..................................................
Zoning District ......................................Fire District .................. V
i ....
Name of Owner ............� i— Wbr. l Address ..................!/.Q ....J..(.... ...... A�.....
Name of Builders ...................Address
Nameof Architect ..................................................................Address .............................. ... .................................................
Number of Rooms ................... .. ........................................Foundation
Exterior ..............4�✓..�� .... 7G<..`. 17�� 5......../.................Roofing �j G �'� .. ��.. .......
Floors . ....Interior S �( ! G
.... .........f... . ................ ':.. ....... ................. .
2
Heating ....:.:...:...-.F ..K......�4.5..................Plumbing ......................... ....1 :72 ...............................
Fireplace ..................1 ��1''`'.!f' ..............................Approximate Cost ..................-.C.. .....� .U.. ...................
r
Definitive Plan Approved by Planning Board - - 2— --------- 19- _ Area ..... ..... .! �
Diagram of Lot and Building with Dimensions / �/ C C
� C)U�l' Fee 97 J.....�..'.. ...i... .....`..1.....
SUBJECT TO APPROVAL OF BOARD OF HEALTH
J
f .
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barns .e regardi he above
construction.
Name .....:..............`................. . .... ... ..................
Construction Supervisor's License ....1,(�..(1.(.. .(.... .
GREENBRIER CORP.
No.27499..:.. Permit for .l z..Story
Single Family Dwelling.......................
Location ...Lot 22 ..........
..
Greenbrier...... ?Co
`::
Owner ......................... ..............................
Type of Construction .......Zrawe........................
Plot ... ........................ Lot ................................
Permit Granted .... '..7...............19 85
Date of Inspection ..........:.........................19
Date Completed ....;..
I 2
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43560 SF
I.SO ��iN Frtour�
3a/is� is NI,r �Frn,�ucs
c3� ''� CERTIFIED PLOT.�.�� ra,`�:r PLAN
RQUMFU
DRUCE l
c LOT 2-2RE
M/w/To.V LA/V E �L-M£K1�/LLE
IN
SCALE, . / = l�[� DATE Fel- 9'- CBS i
GE EN01 EE lNG CO.I 1 CERTIFY THAT- THE F0f-/,/L0_r1o.y
EGI'9TERED REGISTERED CLIENTGa ,vQaiEQ SHOWN ON THIS PLAN 19 LOCATED
CIVIL LAND JOB N0.832.09 ON THE GROUND AS INDICATED AND
ENGINEER ,SURVEYOR4 DR,9Yl JD�R CONFORMS TO THE ZONING LAWS
OF BARNSTABLE, MASS.
712 M A I 'N STREET CH.BY' . �s �
HYANRIS, MASS. 'SHEET_LOF_I ATE REG. LAND SURVEYOR
TOWN OF BARNSTABLE Permit No. --77.t4Q V
Building Inspector{ si Cash ------___---
was
i
ieaa � °
OCCUPANCY PERMIT Bond _X
Issued to (gym_ Address
Ti-*, 22, SR Mini-r" TanP. 0Q-M c rville
Wiring Inspector / Inspection date
Plumbing Inspector j�f, Ji J Inspection date
J
Gas Inspector ,n A G�� ( _ Inspection date >G j, y 7 9.�i S
..�
�. Engineering Department �� A l ^'���� �� f Inspection date Z.7
Board of Health _ r f. F Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND-IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
r
19 -�
I Building Inspector
11l02 194 17:02 Z`617 7 27 7 122 DEPT IND ACCID Q 001
2apartrnent o�y t trial„�fcctdenl�
600 W o 44V ton St,
et
James J.Campbell . Uolton, /l�jassac 02111
Commissioner
Workers' Compensation Insurance Affidavit
with a prindpal place of business at:
(2,L/1 � � ol (a.
(cayisr>�rz�, .
do hereby certify under the pains and penalties of perjury, that--
0 1 am an employer providing workers' Compensation) coverage for my employees working on
this job.
Insurance Company Policy Number
I am a sole proprietor and have no one wonting for title in any capaci*y,
() I am a sole proprietor, general contractor or homeowner (circle one) and have hired the
contractors listed below who have the following workers' compensation policies:
Contractor Insurance Company/Policy ?dumber
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
() I am z horneovvner performing all the work myself.
ccZ:y of&i<s_tement will be fow:arded tc d:e Office of In es-tiptons of d:e DIA for co%Trage verification and that failure to wure
cc.crage as rec,�::tt cr.cer Sec::on 25A of MGL 152 czr,leas to t-�.e Lr,G-csition of cniminal per.alt;es consis rie of a fine of up to 51,50,00.00 and/er cr.=
imrriic'^En; ;; well 2s civil penaltiu in the fc-r-.cf a STOP WORK ORDER and a fine of 5100.00 a day agairut me.
Signed this day ofc�C'• 19 `'] L/
L' nseelPermi tee Building Department
Licensing Board
Seiectmens Office
Health Department
TO VERIFY COVERAGE INFORMATION CALL: L17-727-4900 X403 404, 405, 409, 375
TOWN OF BARNSTABLE BUILDING PERMIT
j
r r � ✓ll6 �411�1�Z47i��1%�I�I�GLLIy ��.I�d'Ksa/(/U�IK�.��[.LO i .
HOME IMPROVEMENT CO
N' RACTORS REGISTRATION
Board of Building Regulations and Standards!
One Ashburton Pl;ice• - Room 1301
Boston , Massactiusbtts 02108
HOME IMPROVEMENT CONTRACTOR
------------------ ---------- -- - - -
Registration 100502 Expiration 06/18/96 r
Type PRIVATE CORPORATION
j ROME IMPROVEMENT CONTRACTOR
I Registration 100502
AMERICAN REMODELING INC Type - PRIVATE CORPORATION
Charles Cook I Eipiration 06/16/96
8585 NORTH STEMMONS #S1.2 I
DALLAS TX 75247 AMERICAN REMODELING INC
ie�.0 7F'i Ces Cook
5@5INORTH SUMMONS tS102
AMAMSTRATOR DALLAS TX 752/7
accordance with the' proviaious of .MCL c 40. S 54, a condition of
In
in accordance
ance Nuisl►dr La that cl►e dubrid rYiulcLa'a LrGIM
of !n a properly l
claim work ►hull. be dl►�po►►od iceuseJ solid waste
dL*poaal tucllity as def Lowd by NCI. c 111. 5 15VA•
e ad
of in which City or Town S2�C�'
The debris wi 11 be d S p�+ tiT9K**E AUL�Kt�S
ggok
S
LAL -,� �> d�) .,
TYIIX OF "TAINIKK
VGA
TkANSIOUNTATI OH
• Sldu.► urd uL Nerwlc App.LLcL►►L
COMMONWEALTROF MASSACHUS=S
DEMKIMENT OF INDUSTRIAL ACCIDENTS
600 WASHINGTON STREET
fames. GamDoel, BOSTON, MASSACHUSETTS 02111
�omr:ss,oner WORKERS' COMPENSATION INSURANCE AFFIDAVIT
(licensee/perminee)
with a principal place of business/residence at: I
V- f2-01%�JQ
(City/Sate/Zi
do hcrcby,certify, under the pains and penalties of perjury, that:
[ J 1 am an"em to er providing the following workers' compensation coverage form employees workin on this
P Y P g g P g Yg
job.
a,nsurance Company Policy Number
( J I am a sole proprietor and have no one working for me.
( J I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors'lisced below
who have the following workers' compensation insurance policies:
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
Q 1 am a homeowner performing all the work myself.
NOTE: Please be'aware that while homeowners who employ persons to do maintenance,construction or repair work on a
dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally
considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)),application by a homeowner for a license
or permit may evidence the legal status of an employer under the Workers' Compensation Act.
1 understand that a copy ofratrit statement will be forwarded to the Department of Industrial Accidents'Office of Insurance for coverage
wrificacion and 64,at failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fineof up to $1500.00 and/or imprisonment of up to one yeu and civil penalties in the form of a Stop Work Order and a
fine of S 100.00 a day against me.
this \ Y Vedes of C-- 19
Ua"A6L. �w e
Licensee/Per Licensor/PermiErpr
Suggested Affidavit for Home Improvement Contractor Permit Application
For omea U"ooyr NAME OF Cl
Perth No. r, o
D�1s
AFFIDAVIT
Home Improvement Contractor IAw
Supplement to Permit Application
MOLc.11=Aloquttoathatthoorc nnar^cilon miteradnn renwnflon.rewir mndeenisiri ootrvenionAinimmment.mmoval.demolition.
or construction or an addition to any nretxialine owner-ccunied building containing al least one but not more than(ourdwelline units....or
to structure which arc adiacenl to ouch residence or building'be done by rt`islered aonitactucs,with Certain awcptiotuc,stung with oll►cr
rog4iretaenu.'
Type of Work:__L I"1/, A 7� Est. Cost
Address of Work
Owner Name:
Date of Permit Application: _
1 hereby certify that:
' 70nistration is not required for the following reason(s):
Work excluded by law
Job under $1,000
Building not owner-occupied
Owner pulling own permit
_Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL
c. 142A.
Signed under penalties of perjury: ,V„ ,1p6. oi ,
I hereby apply for a permit as the agent of the owner: r ' �+
i ` —ram'
Date Contractor Name I Registration No.
OR:
Notwithstanding the above notice. I hereby apply for a.permit as the owner of the above property:
i
Date Owner Name
T -c
Assessor's Office(lst floor2 Mali �L�Q S� Permit# �(03
Conservation Office 4th floor Date Issued
Board of Health Oid floor
Engineering Dept. Ord floor) House#
Planning Dept. (1st floor/School Admin.Bldg.): iSAMSTARMi
M ..
Definitive Plan Approved by Planning Board 19
(Applications processed 8:30-9:30 a.m.& 1:00-2:00 p.m.)
,
TOWN OF BARNSTABL,E
Building Permit Application
Proiect Street Address �T I�
Village 12f , Z-111 �26 b -4�' Fire District
Chvncr .iS� I �JF Address T
Telephone �,7 /
�Permit Re uest: r 6 �11 ' f
i'
Zoning District Flood Plain Water Protection
Lot Size Grandfathered
Zoning Board of Appeals Authorization Recorded
Current Use Propgsed Use
Construction IyX
Eaistin2 Information
Dwelling Type: Single Family Two family Multi-family
Age of structure Basement type
Historic House Finished
Old Kings Highway Unfinished
Number of Baths No. of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name C-/�+1 � l.Y r Telephone number dry /
Address 1- t' ,v License# /
Home Improvement Contractor#
Worker's Compensation #CV7g (art (-(I- 1,L)cE7--jz,?-
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL ONSTR IO DEBRIS RESULTING OM THIS PROJECT WILL BE TAKEN TO � .
Pro'ect Cost
Fee
SIGNA DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
BPERM T
r
A=174-029 X FOR OFFICE USE ONLY
i . PERMIT 12-06-94
ADDRESS 58 MINTON LANE VILLAGE -W. BARNSTABLE ;
OWNER MIKE ZITOLA
r
DATE OF INSPECTION:
. A
FOUNDATION 4
L FRAME
INSULATION
I
FIREPLACE
ELECTRICAL: ROUGH FINAL
,PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL o
FINAL BUILDING: a
DATE CLOSED OUT: l 6 4 C zO
ASSOCIATE PLAN NO.